Provider First Line Business Practice Location Address:
115 HIGHWAY 81 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42327-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-273-5205
Provider Business Practice Location Address Fax Number:
270-273-5241
Provider Enumeration Date:
03/28/2011